Tag: statistics

PLoS One. 2022 Mar 2;17(3):e0264060. doi: 10.1371/journal.pone.0264060. eCollection 2022.

ABSTRACT

High quality daily testing for the presence of the SARS-CoV-2 in workplace settings has become part of the standard and mandatory protection measures implemented widely in response to the current pandemic. Such tests are often limited to a small fraction of the attending personnel due to cost considerations, limited availability and processing capabilities and the often cumbersome requirements of the test itself. A maximally efficient use of such an important and frequently scarce resource is clearly required. We here present an optimal testing strategy which minimises the presence of pre-symptomatic and asymptomatic infected members of the population in a workplace setting, derived under a series of simplifying statistical assumptions. These assumptions however, retain many of the generalities of the problem and yield robust results, as verified through a number of numerical simulations. We show that reduction in overall infected-person-days, IPD, by significant percentages can be achieved, for fixed numbers of tests per day of 5% and 10% of the population, of 30% and 50% in the IPD numbers, respectively.

PMID:35235566 | DOI:10.1371/journal.pone.0264060

PLoS One. 2022 Mar 2;17(3):e0263461. doi: 10.1371/journal.pone.0263461. eCollection 2022.

ABSTRACT

Angiotensin-receptor blockers (ARBs) are a class of drugs approved for the treatment of several common conditions, such as hypertension and heart failure. Recently, regulatory agencies have started to identify possibly carcinogenic nitrosamines and azido compounds in a multitude of formulations of several ARBs, resulting in progressive recalls. Furthermore, data from several randomized controlled trials suggested that there is also a clinically increased risk of cancer and specifically lung cancer with ARBs; whereas other trials suggested no increased risk. The purpose of this analysis was to provide additional insight into the ARB-cancer link by examining whether there is a relationship between degree of cumulative exposure to ARBs and risk of cancer in randomized trials. Trial-level data from ARB Trialists Collaboration including 15 randomized controlled trials was extracted and entered into meta-regression analyses. The two co-primary outcomes were the relationship between cumulative exposure to ARBs and risk of all cancers combined and the relationship between cumulative exposure and risk of lung cancer. A total of 74,021 patients were randomized to an ARB resulting in a total cumulative exposure of 172,389 person-years of exposure to daily high dose (or equivalent). 61,197 patients were randomized to control. There was a highly significant correlation between the degree of cumulative exposure to ARBs and risk of all cancers combined (slope = 0.07 [95% CI 0.03 to 0.11], p<0.001), and also lung cancer (slope = 0.16 [95% CI 0.05 to 0.27], p = 0.003). Accordingly, in trials where the cumulative exposure was greater than 3 years of exposure to daily high dose, there was a statistically significant increase in risk of all cancers combined (I2 = 31.4%, RR 1.11 [95% CI 1.03 to 1.19], p = 0.006). There was a statistically significant increase in risk of lung cancers in trials where the cumulative exposure was greater than 2.5 years (I2 = 0%, RR 1.21 [95% CI 1.02 to 1.44], p = 0.03). In trials with lower cumulative exposure to ARBs, there was no increased risk of all cancers combined or lung cancer. Cumulative exposure-risk relationship with ARBs was independent of background angiotensin-converting enzyme inhibitor treatment or the type of control (i.e. placebo or non-placebo control). Since this is a trial-level analysis. the effects of patient characteristics such as age and smoking status could not be examined due to lack of patient-level data. In conclusion, this analysis, for the first time, reveals that risk of cancer with ARBs (and specifically lung cancer) increases with increasing cumulative exposure to these drugs. The excess risk of cancer with long-term ARB use has public health implications.

PMID:35235571 | DOI:10.1371/journal.pone.0263461

Vestn Oftalmol. 2022;138(1):23-30. doi: 10.17116/oftalma202213801123.

ABSTRACT

Primary open-angle glaucoma (POAG) is the most common form of glaucoma. Insufficient information about the pathogenetic aspects of POAG development necessitates further research of the main clinical, functional, and genetic risk factors for the disease development, as well as their correlations using modern methods of mathematical analysis.

PURPOSE: To assess the significance of risk factors in POAG development based on multivariate analysis of variance.

MATERIAL AND METHODS: The study included 348 patients (348 eyes) with stages I-IV POAG aged 45 to 87 years, who underwent a comprehensive ophthalmological and genetic examination. The control group consisted of 48 individuals (48 eyes) without glaucoma, matched with POAG patients in terms of gender and age. Ophthalmological examination of patients was carried out in 2013-2019 at the «Optimed» Laser Eye Surgery Center in Ufa, molecular genetic research – at the Institute of Biochemistry and Genetics of the Ufa Federal Research Center of the Russian Academy of Sciences. The results were statistically processed using the IBM SPSS Statistics v.21 program. The multivariate analysis employed the principal component method. Correlations between patient parameters and main factors were calculated using the method of rotation – varimax. The significance level was taken equal to 0.05 when testing statistical hypotheses.

RESULTS: Factor analysis was used to rank the factors associated with POAG development, the following variables were attributed to the most significant indicators of high risk (16.75% of the total variance) of developing the disease: age, comorbidity index, cataract, pseudoexfoliative syndrome, pigmentation intensity in the anterior chamber angle.

CONCLUSION: Factor analysis is a multivariate method of mathematical analysis that allows studying the role of the risk factors for POAG development and their association with the disease, which contributes to early diagnosis and identification of clinical and functional features of the disease.

PMID:35234417 | DOI:10.17116/oftalma202213801123

HIV Med. 2022 Mar 1. doi: 10.1111/hiv.13265. Online ahead of print.

ABSTRACT

OBJECTIVES: To pinpoint factors associated with low-level viraemia (LLV) and virological failure (VF) in people living with HIV in the era of high-efficacy antiretroviral treatment (ART) and widespread use of integrase strand transfer inhibitor (INSTIs)-based ART.

METHODS: We included adults aged > 18 years starting their first ART between 2015 and 2018 in the Spanish HIV/AIDS Research Network National Cohort (CoRIS). Low-level viraemia was defined as plasma viral load (pVL) of 50-199 copies/mL at weeks 48 and 72 and VF was defined as pVL ≥ 50 copies/mL at week 48 and pVL ≥ 200 copies/mL at week 72. Multivariable logistic regression models assessed the impact on LLV and VF of baseline CD4 T-cell count, CD4/CD8 T-cell ratio and pVL, initial ART classes, age at ART initiation, time between HIV diagnosis and ART initiation, gender and transmission route.

RESULTS: Out of 4186 participants, 3120 (76.0%) started INSTIs, 455 (11.1%) started boosted protease inhibitors (bPIs) and 443 (10.8%) started nonnucleoside reverse transcriptase inhibitors (NNRTIs), either of them with two nucleos(t)ide reverse transcriptase inhibitors (NRTIs). Low-level viraemia was met in 2.5% of participants and VF in 4.3%. There were no significant differences throughout the years for both virological outcomes. Baseline HIV-1 RNA > 5 log₁₀ copies/mL was the only consistent predictor of higher risk of LLV [adjusted odds ratio (aOR) = 9.8, 95% confidence interval (CI): 2.0-48.3] and VF (aOR = 5.4, 95% CI: 1.9-15.1), even in participants treated with INSTIs.

CONCLUSIONS: The rates of LLV and VF were low but remained steady throughout the years. Baseline HIV-1 RNA > 5 log₁₀ copies/mL showed a persistent association with LLV and VF even in participants receiving INSTIs.

PMID:35234328 | DOI:10.1111/hiv.13265

Rehabil Nurs. 2022 Mar-Apr 01;47(2):43-49. doi: 10.1097/RNJ.0000000000000361.

ABSTRACT

PURPOSE: Nursing assistant turnover is a growing healthcare concern that negatively impacts healthcare organization work environments and has significant financial implications. The purpose of this study was to implement a career ladder program for rehabilitation nursing technicians-nursing assistants who specialize in performing care duties aligned with therapeutic goals in inpatient rehabilitation. The study evaluated the effect on organizational quality metrics of employee engagement, job satisfaction, and annual turnover of rehabilitation nursing technicians.

DESIGN: This pilot study was conducted using a quality improvement approach and a between-subjects pretest-posttest design.

METHODS: A three-tier career ladder intervention for rehabilitation nursing technicians in a 76-bed inpatient rehabilitation facility was implemented. Employee engagement and job satisfaction were evaluated in all rehabilitation nursing technicians (n = 44), with a pre-implementation sample size of n = 23 and a post-implementation sample size of n = 21, from January 2020 through December 2020. Twelve rehabilitation nursing technicians participated in the intervention, which consisted of online learning modules, added job responsibilities, and continuing education and were included in the post-implementation sample size. Nondirectional statistical tests were performed with the level of significance set at .05 (two tailed).

FINDINGS: A majority of the pre-post intervention sample (n = 44) were female (91%), African American (91%), and aged 30-59 years. Employee engagement increased from 78% favorable in 2019 to 86% favorable in 2020. Overall job satisfaction improved from 74% favorable in 2019 to 86% favorable in 2020. Annual turnover decreased from 35% in 2019 to 31% in 2020.

CONCLUSION: In this pilot study, a career ladder program for rehabilitation nursing technicians was effective in increasing and improving employee engagement and job satisfaction while reducing turnover.

CLINICAL RELEVANCE: Rehabilitation nursing technicians are crucial members of the interdisciplinary rehabilitation team providing direct bedside care to optimize patient function. Rehabilitation nursing technician career ladders have the capacity to engage an often underrecognized employee population by creating a positive work environment that promotes job growth and retention in the rehabilitation setting.

PMID:35234404 | DOI:10.1097/RNJ.0000000000000361

Nurs Crit Care. 2022 Mar 2. doi: 10.1111/nicc.12766. Online ahead of print.

ABSTRACT

BACKGROUND: Family-centred care (FCC) is an approach to promote family and health care provider partnership. This has been incorporated into neonatal intensive care units (NICUs) worldwide. However, FCC in low resource health settings, such as Thailand, is challenging and further impacted by coronavirus disease 2019 (COVID-19).

AIMS: To evaluate FCC innovations to improve respect, collaboration and support in a Thai NICU.

STUDY DESIGN: A quasi-experimental study was conducted in an NICU in southern Thailand. Pre-implementation was prior to COVID-19, and parental and staff perceptions of FCC were measured via Perceptions of Family Centred Care-Parent (PFCC-P) and -Staff (PFCC-S) survey. The FCC innovations were developed by stakeholders based on the COVID-19 restrictions, pre-survey results, parents’ and clinicians’ interviews and integrative review, then implemented via a flowchart. Post-implementation evaluation was via repeated surveys. Comparisons were made pre-and post-implementation, with Mann-Whitney U-test statistics for parents and Wilcoxon’s Rank Sum for staff.

RESULTS: A total of 185 (85 pre; 100 post) parents and 20 (pre and post; paired group) health care professionals participated. Because of COVID-19, many planned interventions were unfeasible, however, other innovations achieved (e.g., structured telephone updates, information booklet revision). There was an increase in parents’ perception of respect ([median] 2.50-3.50), collaboration (2.33-3.33) and support (2.60-3.60) domains and overall (2.50-3.43; p < .001; 95% CI: 2.93-3.11). Interdisciplinary professionals’ perception of FCC did not significantly change pre-and post-implementation/COVID-19 pandemic for respect (3.00-2.92), collaboration (3.22-3.33), support (3.20-3.20) and overall (3.15-3.20; 95% CI: 3.10-3.25).

CONCLUSION: Despite the challenges of COVID-19 restricting NICU access, the provision of FCC was maintained and even improved.

RELEVANCE TO CLINICAL PRACTICE: Further research is necessary to develop FCC practice innovations associated with communication, across diverse health care systems and resources.

PMID:35234320 | DOI:10.1111/nicc.12766

Vet Surg. 2022 Mar 2. doi: 10.1111/vsu.13789. Online ahead of print.

ABSTRACT

OBJECTIVE: To determine the influence of perfusate volume on synovial fluid amikacin concentrations in the joints of the hind limb after standing saphenous intravenous regional limb perfusion (IVRLP).

STUDY DESIGN: Randomized crossover design.

ANIMALS: Six adult horses.

METHODS: Saphenous IVRLP was performed in 6 standing horses with 1 g of amikacin diluted with 0.9% NaCl to volumes of 10 ml, 60 ml, and 120 ml. Samples of synovial fluid from the tarsocrural, metatarsophalangeal, and hind limb distal interphalangeal joints were collected at 15 and 30 min after perfusate administration. Concentrations of 40 μg/ml and 160 μg/ml were considered therapeutic for susceptible and resistant pathogens, respectively.

RESULTS: No difference in synovial fluid amikacin concentrations was detected between volumes in any joint (P = .4). All synovial fluid amikacin concentrations were higher at 30 min compared to 15 min (P = .003). All median synovial fluid amikacin concentrations at 30 min were > 40 μg/ml using the 60 ml and 120 ml volumes. Synovial fluid amikacin concentrations >40 μg/ml were only reached in the hind limb distal interphalangeal joint when the 10 ml volume was used. All median synovial fluid amikacin concentrations observed were < 160 μg/ml.

CONCLUSIONS: Target concentrations for pathogens that were considered susceptible were consistently reached with perfusate volumes of 60 ml and 120 ml. However, median synovial fluid amikacin concentrations did not reach target levels for resistant pathogens.

CLINICAL SIGNIFICANCE: Perfusate volumes of 60 ml or 120 ml are recommended to treat infections due to susceptible pathogens in the joints of the distal hind limb. These results justify investigation of saphenous IVRLP with different perfusate volumes using higher doses of amikacin.

PMID:35234300 | DOI:10.1111/vsu.13789

Child Care Health Dev. 2022 Mar 1. doi: 10.1111/cch.12994. Online ahead of print.

ABSTRACT

PURPOSE: This study aimed to understand the impact of the initial COVID-19 pandemic remote schooling period on self-reported wellness among adolescents in Chicago.

METHODS: Students (n=55) completed a 22-item wellness questionnaire before (February 2020) and shortly after the onset of the COVID-19 outbreak (April 2020). Pre/post comparisons (overall and by survey item) were evaluated using two-sided paired t-tests with an alpha level of 0.05. Descriptive statistics were used to evaluate mean scores overall by demographic variables.

RESULTS: Significant differences were found in the following areas: Balance (Pre: 7.3, During: 6.4, p=0.02), Education (Pre: 8.4, During 7.7, p=0.03) and Friends (Pre:8.0, During: 6.3, p=0.001). Overall wellness scores varied by demographic variables, though not significantly.

CONCLUSIONS: Results suggest the onset of the pandemic impacted students’ ability to effectively learn, as well as to maintain balance in their lives and social relationships. Comprehensive support is needed in these areas to promote adolescent wellness.

PMID:35234301 | DOI:10.1111/cch.12994

Paediatr Perinat Epidemiol. 2022 Mar 2. doi: 10.1111/ppe.12840. Online ahead of print.

ABSTRACT

BACKGROUND: The COVID-19 pandemic has accelerated pregnancy outcome research, but little attention has been given specifically to the risk of congenital anomalies (CA) and first trimester exposures.

OBJECTIVES: We reviewed the main data sources and study designs used internationally, particularly in Europe, for CA research, and their strengths and limitations for investigating COVID-19 disease, medications and vaccines.

POPULATION: We classify research designs based on four data sources: a) spontaneous adverse event reporting, where study subjects are positive for both exposure and outcome, b) pregnancy exposure registries, where study subjects are positive for exposure, c) congenital anomaly registries, where study subjects are positive for outcome and d) population healthcare data where the entire population of births is included, irrespective of exposure and outcome.

STUDY DESIGN: Each data source allows different study designs, including case series, exposed pregnancy cohorts (with external comparator), ecological studies, case-control studies and population cohort studies (with internal comparator).

METHODS: The quality of data sources for CA studies is reviewed in relation to criteria including diagnostic accuracy of CA data, size of study population, inclusion of terminations of pregnancy for foetal anomaly, inclusion of first trimester COVID-19-related exposures and use of an internal comparator group. Multinational collaboration models are reviewed.

RESULTS: Pregnancy exposure registries have been the main design for COVID-19 pregnancy studies, but lack detail regarding first trimester exposures relevant to CA, or a suitable comparator group. CA registries present opportunities for improving diagnostic accuracy in COVID-19 research, especially when linked to other data sources. Availability of inpatient hospital medication use in population healthcare data is limited. More use of ongoing mother-baby linkage systems would improve research efficiency. Multinational collaboration delivers statistical power.

CONCLUSIONS: Challenges and opportunities exist to improve research on CA in relation to the COVID-19 pandemic and future pandemics.

PMID:35234297 | DOI:10.1111/ppe.12840

Cochrane Database Syst Rev. 2022 Mar 2;3:CD002795. doi: 10.1002/14651858.CD002795.pub3.

ABSTRACT

BACKGROUND: Posttraumatic stress disorder (PTSD) is a prevalent and disabling disorder. Evidence that PTSD is characterised by specific psychobiological dysfunctions has contributed to a growing interest in the use of medication in its treatment.

OBJECTIVES: To assess the effects of medication for reducing PTSD symptoms in adults with PTSD.

SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL; Issue 11, November 2020); MEDLINE (1946-), Embase (1974-), PsycINFO (1967-) and PTSDPubs (all available years) either directly or via the Cochrane Common Mental Disorders Controlled Trials Register (CCMDCTR). We also searched international trial registers. The date of the latest search was 13 November 2020.

SELECTION CRITERIA: All randomised controlled trials (RCTs) of pharmacotherapy for adults with PTSD.

DATA COLLECTION AND ANALYSIS: Three review authors (TW, JI, and NP) independently assessed RCTs for inclusion in the review, collated trial data, and assessed trial quality. We contacted investigators to obtain missing data. We stratified summary statistics by medication class, and by medication agent for all medications. We calculated dichotomous and continuous measures using a random-effects model, and assessed heterogeneity.

MAIN RESULTS: We include 66 RCTs in the review (range: 13 days to 28 weeks; 7442 participants; age range 18 to 85 years) and 54 in the meta-analysis. For the primary outcome of treatment response, we found evidence of beneficial effect for selective serotonin reuptake inhibitors (SSRIs) compared with placebo (risk ratio (RR) 0.66, 95% confidence interval (CI) 0.59 to 0.74; 8 studies, 1078 participants), which improved PTSD symptoms in 58% of SSRI participants compared with 35% of placebo participants, based on moderate-certainty evidence. For this outcome we also found evidence of beneficial effect for the noradrenergic and specific serotonergic antidepressant (NaSSA) mirtazapine: (RR 0.45, 95% CI 0.22 to 0.94; 1 study, 26 participants) in 65% of people on mirtazapine compared with 22% of placebo participants, and for the tricyclic antidepressant (TCA) amitriptyline (RR 0.60, 95% CI 0.38 to 0.96; 1 study, 40 participants) in 50% of amitriptyline participants compared with 17% of placebo participants, which improved PTSD symptoms. These outcomes are based on low-certainty evidence. There was however no evidence of beneficial effect for the number of participants who improved with the antipsychotics (RR 0.51, 95% CI 0.16 to 1.67; 2 studies, 43 participants) compared to placebo, based on very low-certainty evidence. For the outcome of treatment withdrawal, we found evidence of a harm for the individual SSRI agents compared with placebo (RR 1.41, 95% CI 1.07 to 1.87; 14 studies, 2399 participants). Withdrawals were also higher for the separate SSRI paroxetine group compared to the placebo group (RR 1.55, 95% CI 1.05 to 2.29; 5 studies, 1101 participants). Nonetheless, the absolute proportion of individuals dropping out from treatment due to adverse events in the SSRI groups was low (9%), based on moderate-certainty evidence. For the rest of the medications compared to placebo, we did not find evidence of harm for individuals dropping out from treatment due to adverse events.

AUTHORS’ CONCLUSIONS: The findings of this review support the conclusion that SSRIs improve PTSD symptoms; they are first-line agents for the pharmacotherapy of PTSD, based on moderate-certainty evidence. The NaSSA mirtazapine and the TCA amitriptyline may also improve PTSD symptoms, but this is based on low-certainty evidence. In addition, we found no evidence of benefit for the number of participants who improved following treatment with the antipsychotic group compared to placebo, based on very low-certainty evidence. There remain important gaps in the evidence base, and a continued need for more effective agents in the management of PTSD.

PMID:35234292 | DOI:10.1002/14651858.CD002795.pub3